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新西兰难民的医疗需求和获取医疗服务的障碍:一种定性现象学方法。

Refugee healthcare needs and barriers to accessing healthcare services in New Zealand: a qualitative phenomenological approach.

机构信息

Inpatient Pharmacy, Waitemata District Health Board, Auckland, New Zealand.

School of Pharmacy, Faculty of Medical and Health Sciences, Auckland University, Auckland, New Zealand.

出版信息

BMC Health Serv Res. 2022 Nov 3;22(1):1310. doi: 10.1186/s12913-022-08560-8.

Abstract

BACKGROUND

Refuges and asylum seekers have specific healthcare needs; however there has been insufficient attention and effort to address these needs globally. Furthermore, effective communication between healthcare providers and refugees remains poor, further widening the imbalanced power dynamics. The aim of this research project was to examine refugee healthcare needs and current barriers to accessing healthcare services in New Zealand, and to propose solutions by exploring the perceptions, attitudes, beliefs, and opinions of key stakeholders regarding refugee healthcare needs within the scaffold of health and social care systems.

METHODS

We conducted semi-structured interviews between September and December 2018 with 18 purposively selected refugee service provider stakeholders in New Zealand using an interview guide that addressed healthcare needs, existing barriers to access healthcare services, and perceived future healthcare delivery solutions.

RESULTS

Thematic analysis of emergent themes of this study indicated the need for a national framework of inclusion, mandating cultural safety training of frontline personnel, improving access to interpreters and cultural mediators, and establishing the role of patient navigators. Barriers to accessing health services included entrenched social health determinants such as housing scarcity and disenfranchised community environments; refugee health-seeking behaviour and poor health literacy; along with existing social support networks. We propose that healthcare delivery should focus on capacity building of existing services, including co-design processes with refugees and asylum seekers and increasing funding for refugee-specific health service via the implementation of an overarching national strategy.

CONCLUSION

Based on the findings of this study, refugee organisations and their frontline personnel should seek to address the deficiencies identified in order to provide equitable, timely and culturally-accessible healthcare services for refugees in New Zealand and in comparable countries.

摘要

背景

难民和寻求庇护者有特殊的医疗需求;然而,全球对这些需求的关注和努力不足。此外,医疗服务提供者与难民之间的有效沟通仍然很差,进一步扩大了不平衡的权力动态。本研究项目旨在探讨新西兰难民的医疗需求以及获得医疗服务的当前障碍,并通过探索关键利益相关者对难民医疗需求的看法、态度、信念和意见,在卫生和社会保健系统的框架内,提出解决方案。

方法

我们于 2018 年 9 月至 12 月期间,使用一个包含医疗需求、现有获取医疗服务障碍以及感知未来医疗服务提供解决方案的访谈指南,对新西兰的 18 名难民服务提供者利益相关者进行了半结构式访谈。

结果

对本研究中出现的主题的主题分析表明,需要建立一个包含所有人群的国家框架,要求前线人员接受文化安全培训,改善口译员和文化调解员的获取途径,并建立患者导航员的角色。获取卫生服务的障碍包括住房短缺和被剥夺公民权利的社区环境等根深蒂固的社会健康决定因素;难民寻求医疗保健的行为和较差的健康素养;以及现有的社会支持网络。我们建议,医疗服务的提供应侧重于现有服务的能力建设,包括与难民和寻求庇护者共同设计流程,并通过实施全面的国家战略,为特定的难民健康服务增加资金。

结论

基于本研究的结果,难民组织及其前线人员应努力解决所确定的不足,以便为新西兰和类似国家的难民提供公平、及时和文化上可获得的医疗服务。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8570/9635126/d894bf11b17c/12913_2022_8560_Fig1_HTML.jpg

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